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Benign paroxysmal positional vertigo (BPPV)

Benign paroxysmal positional vertigo, also called BPPV, is one of the most common causes of vertigo. Vertigo is the sudden feeling of spinning or moving.

BPPV causes brief periods of mild to intense dizziness. Certain changes in the head’s position most often set them off. This might happen from tipping the head up or down, lying down, or turning over or sitting up in bed.

Although BPPV can be a bother, it’s rarely serious. But it can raise the chance of falling. A healthcare professional can treat BPPV during an office visit.

The symptoms of benign paroxysmal positional vertigo, also called BPPV, may include:

The symptoms of BPPV can come and go. Symptoms most often last less than a minute. Bouts of BPPV can go away for some time and then come back.

What type of head movement brings on BPPV varies from person to person. But a change in head position almost always is what brings on the symptoms. Some people also feel off balance when standing or walking.

Atypical rhythmic eye movements, called nystagmus, most often go with the symptoms of benign paroxysmal positional vertigo.

When to see a doctor

See your healthcare professional if you have dizziness or vertigo that is sudden, intense, lasts long or keeps coming back.

Seek emergency care

It’s not common for BPPV to signal a serious illness. But see your healthcare professional right away if you have dizziness or vertigo with any of the following:

Often, there’s no known cause for BPPV. This is called idiopathic BPPV.

When there is a known cause, BPPV may be linked with a blow to the head. Less common causes of BPPV include conditions that damage the inner ear.

Rarely, the cause can be damage that happens during ear surgery. Or the symptoms can result from being on your back for a time, such as during surgery or bed rest.

The ear’s role

Inside the ear is a tiny organ called the vestibular labyrinth. It includes three loop-shaped structures called semicircular canals. They have fluid and fine, hairlike sensors that detect the head’s movement.

Other structures in the ear, called otolith organs, detect the head’s movements up and down, right and left, back and forth. The otolith organs hold crystals that respond to gravity.

For many reasons, these crystals can move out of place. When the crystals move, they can go into one of the semicircular canals. Certain head movements can cause the crystals to move.

When the crystals move, they cause the semicircular canal to become sensitive to certain head position changes. This is what causes the dizziness.

The risk of benign paroxysmal positional vertigo is higher in people age 50 and older. But it can happen at any age. The condition is more common in people assigned female at birth.

A head injury or any other condition of the balance organs of the ear may raise the risk of BPPV. The bone-thinning condition osteoporosis also might be a risk factor.

BPPV rarely causes complications. The dizziness of BPPV can make you unsteady, which may raise your risk of falling and injury from falls.

To diagnose benign paroxysmal positional vertigo, also called BPPV, your healthcare professional does a physical exam and moves your head into different positions and looks for:

If your healthcare professional can’t find the cause of your symptoms, you may need more tests, such as:

Benign paroxysmal positional vertigo may go away on its own within a few weeks or months. To help relieve BPPV, your healthcare professional, audiologist or physical therapist may treat you with a series of movements called the canalith repositioning procedure.

Canalith repositioning

Done in your healthcare professional’s office, the canalith repositioning procedure involves simple, slow head movements. There are several types of repositioning procedures that a healthcare professional may do. The goal is to move crystals from the fluid-filled semicircular canals of the inner ear into a part of the ear where they won’t cause dizziness.

You hold each position for about 30 seconds after symptoms or atypical eye movements stop. This procedure most often works after one or two treatments.

Your healthcare professional can teach you how to do the procedure on yourself. Then you can do it at home if needed.

Surgery

Rarely, when the canalith repositioning procedure doesn’t work, your healthcare professional may suggest a surgical procedure. The surgery may involve putting in a bone plug to block the part of the inner ear that’s causing dizziness. The plug keeps the semicircular canal in the ear from responding to particle movements or all head movements.

If you have dizziness because of BPPV, work with your healthcare professional to manage your symptoms. And think about the following:

Make an appointment with your main healthcare professional if you have symptoms of BPPV. Your healthcare professional may send you to an ear, nose and throat specialist, also called an ENT, or a doctor who specializes in the brain and nervous system, called a neurologist.

Here’s some information to help you get ready for your appointment.

What you can do

Questions to ask at the first appointment include:

Questions to ask if you are referred to a specialist include:

What to expect from your doctor

Your healthcare professional might ask you questions, such as:

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